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Case Study Solution for the case uploaded in name of 'Parishram'. This competition was won at VGSOM, IIT Kharagpur.Sector: NGO/HealthCare
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ActiveY Parishram
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ActiveY Parishram
Executive Summary
Affordable and quality health care facilities are still dream for majority in rural India; problem
has been further escalated by ignorance and unawareness regarding healthy living. In this
demanding situation, collaboration of all the stakeholders including panchayat, NGOs and
Government is imperative to overhaul the rural health care scenario. NGOs and Government
should now direct more energy towards curative care rather than preventive care. Also transfer of
responsibility and accountability from government institutions to NGOs and panchayat will help
in increasing awareness, eradicating ignorance and bringing in quality health care facilities to the
masses.
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ActiveY Parishram
Introduction
In recent times Indian economy has been growing at tremendous rate and has gained rank in
order of top 10 economies of world. But on the side of human development and health index we
are still positioned in lower half of the ranking. This striking contrast gives us a cue that the
problem is deep rooted not just in policies but also in our socio-economic fabric. In order to find
the cause of this multi-facet problem, identification and analysis is done at social, economic,
financial and political platform.
Problem Identification
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Social Factors
Traditionally we have been oriented towards seeking a cure for an existent medical condition.
But to tackle the increasing health challenges which we face because of unhealthy eating habits
and living condition, we need to focus on preventive care. Curative care differs from preventive
care as it aims at prevention of the diseases through the adoption of proper life styles,
immunization, etc.
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FOCUS ON CURATIVE CAREIGNORANCE ON PART OF PARENTSLACK OF AWARENESSUNHEALTHY EATING HABITSWORKLOAD ON CHILDRENLACK OF SCHOOL INVOLVEMENT IN CHILDREN HEALTH
CONCENTRATION OF RESOURCES IN URBAN AREASINADEQUATE GOVERNMENT HEALTH FACIILITESUNAVAILABILITY OF TRAINED HEALTH WORKERS LACK OF QUALITY HEALTH SERVICESn
NO TIME BOUND GOALNO INVOLVEMENT OF PANCHAYAT OR COMMUNITY COMPETING PRIORITIES
FEW PUBLIC-PRIVATE -NGOs COLLABORATIONNO COMMUNITY BASED HEALTH INSURANCE UNAFFORDABLE HEALTH SERVICES
SOCIAL ECONOMIC
POLITICSFINANCE
ActiveY Parishram
Fig2. Nutritional status of children in India
Majority of the population at the bottom of pyramid is uneducated and unconnected with the
main stream of development initiatives. This has led to:
1. Inability to understand the importance of health in initial years of child mental/physical
development. This lead to overloading child with home tasks.
2. Lack the awareness required to address the child health problem on the basis of early
symptoms.
3. Inability of schools to keep track of child health.
Economic Factors
India faces a huge need gap in terms of availability of number of hospital beds per 1000
population. With a world average of 3.96 hospital beds per 1000 population India stands just a
little over 0.7 hospital beds per 1000 population. Moreover urban-rural divide is very explicit.
There are only 0.2 hospitals beds as compared to 3 in urban areas. Moreover the public
expenditure per 1000 population in rural areas is only Rs. 80,000 as compared to Rs. 560,000 in
urban areas. Unavailability and competency of trained health workers is also a point of concern.
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NUTRITIONAL STATUS OF INDIAN CHILDREN, 2005-06 (IN PER CENT)SOURCE:NATIONAL FAMILY HEALTH SURVEY-3 (2005-06)
CHILDREN UNDER THREE WHO ARE
STUNTEDWASTED
UNDERWEIGHT
URBAN37
19
30
RURAL47
24
44
ALL-INDIA45
23
40
ActiveY Parishram
Political Factors
Large number of well intentioned polices are designed by government but only few of them able
to show the intended results. It is mainly because goals are generally not time bound hence it
brings in corruptions and inefficiency. Moreover panchayat is generally not involved in rollout
hence they fail to bring in the required participation in the health program.
Moreover, there are several parallel health programs going on with each having its own focus
area therefore it sometimes lead to conflict of interest between different agencies which leads to
duplication of efforts and thereby wastage of scarce resources.
Financial Factors
Inadequacy of affordable health care has lead people in rural areas to either opt for inadequate
government health facilities or expensive facilities of private institutions. Though some NGOs
provide medical services through hospitals and mobile vans but these are too few in number to
bring in the necessary affordability and accessibility to health services. Also absence of
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AREAS
HOSPITAL BEDS
DOCTORS
PUBLIC EXPENDITURE
OUT OF POCKET
RURAL(PER 1000 POPULATION)
0.2
0.6
Rs. 80,000
Rs. 750,000
URBAN (PER 1000 POPULATION)
3.0
3.4
Rs. 560,000
Rs. 1,150,000
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community based health insurance has deprived needy people of the ready access to money and
efficient health care services.
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The Immediate Response
Immediate responses are designed to be highly focused and oriented towards masses that are in
dire need of health services.
1. Bringing in medical facility to each and every village would be bit difficult initially
therefore Melas/Haat should be used to launch the concept of a HEALTH CAMP. Since
resources are limited therefore to maximize their utilization we can use same platform for
multiple purpose:
a. Evening/Night time at camp: NGO and government agencies can show especially
designed projected videos showcasing the symptoms of health related issues
covering fields like anemia, TB etc. Also they can highlight the importance of
both preventive and curative methodology.
b. Day time at camp: NGO can invite guest medical practitioners from nearby cities
to provide free consultation along with free distribution of medicine like folic acid
and vitamins to the villagers.
2. NGOs can design special program where they can bring in educated and trained volunteer
from the cities to publicize healthy eating habits in villages. Also volunteer must ensure
with the help of panchayat that they could prevent household chores and manual work for
children below 15 years.
3. NGOs along with district health and education office should actively involve schools in
ensuring the health of children. Regular health camps can be arranged at rural schools to
keep track of various symptoms of disease in children.
4. Village leadership should be convinced to provide subsidized transport to the children
coming from poor background. It will help already malnourished children to maintain
energy level.
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ActiveY Parishram
5. NGO can make use of mHealth, a practice of medical and public health, supported by
mobile devices. mHealth applications include the use of mobile devices in collecting
community and clinical health data, delivery of healthcare information to practitioners
and patients.
Motivations behind using mHealth service arise from 2 factors:
a. Large mass of rural inhabitants, high burden of disease prevalence and low health
care workforce.
b. Potential of lowering information and transaction costs in order to deliver improved
healthcare.
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Long term strategy focus area
Fig. 4 Long term plan outcome
Preventive Health Practices
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CURATIVE CARE
LONG TERM STRATEGY TO
COMBAT HEALTH CARE PROBLEMS OF UNDERPRIVILEGED
PEOPLE
ActiveY Parishram
Till now emphasis on preventive care had been on a lower priority because of the burden of
communicable diseases like TB, Vector borne diseases etc. Improvement in health status
necessitates expanding our energies with equal emphasis on preventive care particularly in
the case of HIV/AIDS, child health, and polio. This can be done by awareness campaigns
emphasizing the need of easily available source of various nutrients, vitamins etc. Also
vitamin and folic acid capsule should be freely distributed especially for children and
pregnant ladies.
On economic front cost effective ratio shows the saving for preventive measure rather than
treatment for existing health problems.
Improvement in Rural Health Care Infrastructure and Services
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ActiveY Parishram
Rural areas have been neglected historically since the main inputs have been limited to family
planning and more recently immunization services. The only way to remedy this gross disparity
is more resources for the health sector at one level and greater equity in distribution of resources
between rural and urban areas at another level.
Partnership with not-for-profit NGOs has also gradually evolved from that of advocacy to actual
partnership in quality service delivery and monitoring since Seventh Five-Year Plan. The
government has shown willingness to hand over the government infrastructure to NGOs or other
forms of people's groups for providing health care to the masses within the assigned budgetary
provision. This option can be tried in selected blocks as a pilot project.
A desired PPP framework under ambit of NRHM would enable capitalization of governmental
resources while ensuring private sector efficiencies in delivery.
Empowerment of Panchayati Raj Institutions
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In order to make health reform touch each and every nook-corner of rural India it is imperative to
empower the community. The Panchayati Raj Institutions (PRI), right from the village level to
district level, would have to be given an ownership of the public health delivery system in their
respective jurisdiction. Village Health Committee should be given certified vocational training
by NGOs and district level health office for capability development so that in near future they
should be able to develop and deliver health plan for each village.
Outcome of one of such field based study in Gujarat:
a. Improvement in the quality of health care services, especially through ensuring
better attendance of health care functionaries at the local level, as well as exerting
moral pressure on health staff not to shirk from work.
b. Watchful participation of local communities has contributed in some measure in
improving the supplies of drug and equipment by assisting health staff by
bringing the deficiencies in the supplies to the attention of higher authorities.
Community based health insurance by NGOs
In a country of over a billion people, barely 30 million are covered under community health
insurance scheme by NGOs and other community organizations. In order to reduce the distress
of poor household, there is therefore an imperative need to involve NGOs and community based
organizations as insurance providers and as a third party administrators. Innovative and flexible
insurance products need to be developed and marketed. The ultimate aim should be to provide
health security to the poor by be ensuring accessible, affordable, accountable and good quality
hospital care.
Fund Generation through Philanthropy
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Philanthropic activity framework in India can be understood with the help of following
constituents.
1. Donors: Individuals, corporations and governments.
2. Supporting Networks: Philanthropic venture, Red Cross, dedicated funds like the Prime
Minister’s National Relief Fund.
3. Grass Root NGO: These NGO disburses donations as part of their healthcare activities.
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In India individual and corporate donations make up only 10 percent of charitable giving. While
by comparison, nearly three-fourths of all philanthropy in the US is undertaken by individuals.
Hence there lies a huge potential in tapping charity from high- net-worth individual.
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